タグ: Haemodialysis

Anabolic exercise in haemodialysis patients: a randomised controlled pilot study

Nutrition rehabilitation in hemodialysis patients is one of the hottest topics. They have reported that resistance exercise has resulted to muscle strength, but the lack of functional capacity. Although this trial has high evidence with RCT, the number of participants may be too small to determine statistically significant.

Anabolic exercise in haemodialysis patients: a randomised controlled pilot study

Danielle L. Kirkman, Paul Mullins, Naushad A. Junglee, Mick Kumwenda, Mahdi M. Jibani, Jamie H. Macdonald

Abstract

Background

The anabolic response to progressive resistance exercise training (PRET) in haemodialysis patients is unclear. This pilot efficacy study aimed to determine whether high-intensity intradialytic PRET could reverse atrophy and consequently improve strength and physical function in haemodialysis patients. A second aim was to compare any anabolic response to that of healthy participants completing the same program.

Methods

In a single blind controlled study, 23 haemodialysis patients and 9 healthy individuals were randomly allocated to PRET or an attention control (SHAM) group. PRET completed high-intensity exercise leg extensions using novel equipment. SHAM completed low-intensity lower body stretching activities using ultra light resistance bands. Exercises were completed thrice weekly for 12 weeks, during dialysis in the haemodialysis patients. Outcomes included knee extensor muscle volume by magnetic resonance imaging, knee extensor strength by isometric dynamometer and lower body tests of physical function. Data were analysed by a per protocol method using between-group comparisons.

Results

PRET elicited a statistically and clinically significant anabolic response in haemodialysis patients (PRET—SHAM, mean difference [95 % CI]: 193[63 to 324] cm3) that was very similar to the response in healthy participants (PRET—SHAM, 169[−41 to 379] cm3). PRET increased strength in both haemodialysis patients and healthy participants. In contrast, PRET only enhanced lower body functional capacity in the healthy participants.

Conclusions

Intradialytic PRET elicited a normal anabolic and strength response in haemodialysis patients. The lack of a change in functional capacity was surprising and warrants further investigation.

Keywords: Weight lifting, Wasting syndrome, Chronic kidney failure, Haemodialysis

Anabolic exercise in haemodialysis patients: a randomised
controlled pilot study

Anabolic exercise in haemodialysis patients: a randomised controlled pilot study

　血液透析患者における栄養リハビリテーションは最近のトピックの一つです．レジスタンス運動は筋力増強をもたらしたものの，身体機能の改善には至らなかったという報告です．無作為化比較試験であり信頼性は高いのですが，参加者人数が少なく有意差が出なかったのではないかとも考えられます．



透析患者における蛋白同化運動：無作為化比較試験

Danielle L. Kirkman, Paul Mullins, Naushad A. Junglee, Mick Kumwenda, Mahdi M. Jibani, Jamie H. Macdonald

要旨

背景

　透析患者における漸増レジスタンス運動 (PRET) への反応は不明確である．このパイロット有効性研究は，透析患者において透析の間での強度の PRET が萎縮を逆転できるか，また結果的に筋力と身体機能を改善することができるか否かを定義することを目的とする．2番目の目的は蛋白同化反応と，同様のプログラムを完遂した健康な参加者の反応とを比較することである．

方法

　単盲検対照試験において 23 名の透析患者と 9 名の健康な個人が無作為に PRET 群と比較対照群 (SHAM) に割り付けられた．PRET 群は強度の運動，つまり新規の設備を使って下肢を進展する運動を完遂した．SHAM 群は軽度の下半身を進展する活動を超軽量の抵抗バンドを用いて完遂した．透析患者の運動は週に 3 回の透析中に，12 週間にわたって行われた．転帰には MRI による膝伸筋容積，アイソメトリックダイナモメーターによる膝伸展力および身体機能の下半身テストが含まれた．データは群間比較を用いたプロトコルメソッドにより解析した．

結果

　PRET は透析患者において統計的および臨床的に有意に蛋白同化反応を惹起し (PRET—SHAM, mean difference [95 % CI]: 193[63 to 324] cm3), 健常な参加者においても同様であった (PRET—SHAM, 169[−41 to 379] cm3). PRET は透析患者においても健常者においても筋力を増強させた．対照的に, PRET は健常者においてのみ下半身の身体機能を増強させただけであった．

結論

　透析患者において透析中の PRET は正常な蛋白同化と筋力増強を惹起した．身体機能に変化がなかったことは驚くべきものであり，さらなる調査が必要と考えられた．

Keywords: Weight lifting, Wasting syndrome, Chronic kidney failure, Haemodialysis

Anabolic exercise in haemodialysis patients: a randomised
controlled pilot study

Geriatric Nutritional Risk Index, a simplified nutritional screening index, is a significant predictor of mortality in chronic dialysis patients

Zadeh has reported that malnutrition-Inflammation Score (MIS) is predictor of mortality in hemodialysis patients. Although Yamada has reported that the significant correlation between Geriatric Nutritional Risk Index (GNRI) and MIS, they did not report the correlation between GNRI and mortality in chronic hemodialysis patients. This article has reported that GNRI is significant predictor of mortality in chronic dialysis patients.

Geriatric Nutritional Risk Index, a simplified nutritional screening index, is a significant predictor of mortality in chronic dialysis patients

Ikue Kobayashi, Eiji Ishimura, Yoko Kato, Senji Okuno, Tadashi Yamamoto, Tomoyuki Yamakawa, Katsuhito Mori, Masaaki Inaba and Yoshiki Nishizawa

Nephrol Dial Transplant (2010) 25: 3361-3365

Abstract

Background

Malnutrition is a common complication in haemodialysis patients. Recently, the Geriatric Nutritional Risk Index (GNRI) has been reported as a simple and accurate tool to assess nutritional status of haemodialysis patients. Our objective was to examine the association between GNRI and mortality in chronic haemodialysis patients.

Methods

We examined the GNRI of 490 maintenance haemodialysis patients (60 ± 12 years, 293 males and 197 females) and followed up these patients for 60 months. Predictors for all-cause death were examined using Kaplan–Meier analysis and Cox proportional analyses.

Results

The GNRI was 98.0 ± 6.0, and was significantly and negatively correlated with age and haemodialysis duration. During the 60-month follow-up period, 129 patients died. According to the highest positive likelihood and risk ratios, the cutoff value of GNRI for mortality was set at 90. Kaplan–Meier analysis revealed that patients with a GNRI <90 (n = 50) had a significantly lower survival rate, compared to those with GNRI ≥90 (n = 440) (log-rank test, P < 0.0001). Multivariate Cox proportional hazards analyses demonstrated that GNRI was a significant predictor for mortality [hazard ratio (HR) 0.962, 95% confidence interval (CI) 0.931–0.995, P < 0.05], after adjustment for age, gender, C-reactive protein, presence of diabetes and haemodialysis duration.

Conclusions

These results demonstrated that GNRI is a significant predictor for mortality in haemodialysis patients. The simple method of GNRI is considered to be a clinically useful marker for the assessment of nutritional status in haemodialysis patients.

Keywords: Geriatric Nutritional Risk Index; haemodialysis; malnutrition; mortality

Geriatric Nutritional Risk Indexは簡易栄養スクリーニング指標であるが，維持透析患者の死亡率の有意な指標である

　維持透析患者の MIS と死亡率との相関 Zadeh らが報告し，GNRI と MIS との相関の強さは Yamada が報告しておりますが，Yamada の報告では GNRI と透析患者の死亡率との比較はありませんでした．この論文は GNRI と透析患者の死亡率とを直接比較した報告です．

Geriatric Nutritional Risk Indexは簡易栄養スクリーニング指標であるが，維持透析患者の死亡率の有意な指標である

Ikue Kobayashi, Eiji Ishimura, Yoko Kato, Senji Okuno, Tadashi Yamamoto, Tomoyuki Yamakawa, Katsuhito Mori, Masaaki Inaba and Yoshiki Nishizawa

Nephrol Dial Transplant (2010) 25: 3361-3365

要旨

背景

　低栄養は透析患者の一般的合併症である．最近 Geriatric Nutritional Risk Index (GNRI) が透析患者の栄養状態を簡易で正確に評価するツールとして報告されるようになってきた．我々の研究では透析患者の GNRI と死亡率との相関を調査した．

方法

　我々は 490 名の維持透析患者 (60 ± 12 歳，男性 293 名，女性 197 名) の GNRI を調査し，60 ヶ月間に渡って経過を観察した．全死亡の指標を Kaplan-Meyer 法と Cox 比例ハザード法で検証した．

結果

　GNRI は98.0 ± 6.0 であり，有意に年齢および透析期間と負の相関があった．60 ヶ月間の観察期間中 129 名が死亡した．死亡を鑑別する GNRI の陽性尤度比が最大となるカットオフ値は 90 であった．Kaplan-Meyer 法によると GNRI 90 未満の患者 (n = 50) の生存率は 90 以上の患者 (n = 440) と比較して有意に低かった(log-rank検定p < 0.0001)．多変量の Cox 比例ハザード解析ではGNRI が死亡率の有意な指標となることが明らかとなった（年齢，性別，CRP, 糖尿病の存在および透析期間で調整後のハザード比 0.962, 95%CI 0.931 – 0.995, p < 0.05）．

結論

　これらの結果は GNRI が透析患者の死亡率の有意な指標であることを示している．この GNRI の簡易な手法は透析患者の栄養状態を評価する臨床的に有用なマーカーであると考えられる．

キーワード：Geriatric Nutritional Risk Index; haemodialysis; malnutrition; mortality